Philosophy of Medicine, Miscellaneous

This article argues that actor-network theory, as an alternative to critical theory, has lost its critical impetus when examining commodification in healthcare. The paper claims that the reason for this, is the way in which actor-network theory’s anti-essentialist ontology seems to black box 'intentionality' and ethics of human agency as contingent interests. The purpose of this paper was to open the normative black box of commodification, and compare how Marxism, Habermas and ANT can deal with commodification and ethics in healthcare. (...) Moreover, a new account of 'intentionality' in critical thinking was elaborated. Using Strawson's analysis of 'reactive attitudes and resentment,' the ethical implications of commodification in health care were examined as an assessment of intentions. Synthesizing critical theory with the relational materialism of actor-network theory, this article advances a new approach that seeks to bridge interdisciplinary boundaries, and guide actor-network theory in a critical and humanist direction. Providing new theoretical insights on commodification and 'intentionality' in health care. (shrink)

This study clarifies the need for a renewed account of the body in physiotherapy to fill sizable gaps between physiotherapeutical theory and practice. Physiotherapists are trained to approach bodily functioning from an objectivist perspective; however, their therapeutic interactions with patients are not limited to the provision of natural-scientific explanations. Physiotherapists’ practice corresponds well to theorisation of the body as the bearer of original bodily intentionality, as outlined by Merleau-Ponty and elaborated upon by enactivists. We clarify how physiotherapeutical practice corroborates Merleau-Ponty’s (...) critical arguments against objectivist interpretations of the body; particularly, his analyses demonstrate that norms of optimal corporeal functioning are highly individual and variable in time and thus do not directly depend on generic physiological structures. In practice, objectively measurable physical deviations rarely correspond to specific subjective difficulties and, similarly, patients’ reflective insights into their own motor deficiencies do not necessarily produce meaningful motor improvements. Physiotherapeutical procedures can be understood neither as mechanical manipulations of patients’ machine-like bodies by experts nor as a process of such manipulation by way of instructing patients’ explicit conscious awareness. Rather, physiotherapeutical practice and theory can benefit from the philosophical interpretation of motor disorders as modifications of bodily intentionality. Consequently, motor performances addressed in physiotherapy are interpreted as relational features of a living organism coupled with its environment, and motor disorders are approached as failures to optimally manage the motor requirements of a given situation owing to a relative loss of the capacity to structure one’s relation with their environment through motor action. Building on this, we argue that the process of physiotherapy is most effective when understood as a bodily interaction to guide patients towards discovering better ways of grasping a situation as meaningful through bodily postures and movements. (shrink)

The use of composite outcomes is becoming widespread in clinical trials. By combining individual outcome measures into a composite, researchers claim a composite can increase statistical precision and trial efficiency, expediting the trial by reducing sample size and cost, and consequently enabling researchers to answer questions that could not otherwise be answered. Another rationale given for using a composite is that it provides a measure of the net effect of the intervention that is more patient-relevant than any single outcome measure. (...) Critics, on the other hand, argue that the use of composites threatens the scientific objectivity of the trial by introducing new risks, and that in practice components are inconsistently defined, unreasonably combined, and inadequately reported. Philosophical scrutiny can help shed light in these disagreements and disentangle ethical and epistemological issues of composites in clinical trials. I examine common use of composites in cardiovascular trials, and show how composite results can be problematic, even misleading, if the proper range of scientific decisions and their consequences are ignored when judging the composite. Philosophies of science that are principled on normative versions of the argument from inductive risk can help explicate issues with composites. I conclude by suggesting ways of remedying composite issues in clinical trials. (shrink)

The purpose of this chapter is to describe what we see as several important new directions for philosophy of medicine. This recent work (i) takes existing discussions in important and promising new directions, (ii) identifies areas that have not received sufficient and deserved attention to date, and/or (iii) brings together philosophy of medicine with other areas of philosophy (including bioethics, philosophy of psychiatry, and social epistemology). To this end, the next part focuses on what we call the “epistemological turn” in (...) recent work in the philosophy of medicine; the third part addresses new developments in medical research that raise interesting questions for philosophy of medicine; the fourth part is a discussion of philosophical issues within the practice of diagnosis; the fifth part focuses on the recent developments in psychiatric classification and scientific and ethical issues therein, and the final part focuses on the objectivity of medical research. (shrink)

A minimal essentialism (‘intrinsic biological essentialism’) about natural kinds is required to explain the projectability of human science terms. Human classifications that yield robust and ampliative projectable inferences refer to biological kinds. I articulate this argument with reference to an intrinsic essentialist account of HPC kinds. This account implies that human sciences (e.g., medicine, psychiatry) that aim to formulate predictive kind categories should classify biological kinds. Issues concerning psychiatric classification and pluralism are examined.

Due to the intricate nature of its subject matter, medicine is always threatened by speculations and disagreements about which among its entities exist, e.g., any specific biological structures, substructures or substances, pathogenic agents, pathophysiological processes, diseases, psychosomatic relationships, therapeutic effects, and other possible and impossible things. To avoid confusion, and to determine what entities an item of medical knowledge presupposes to exist if it is to be true, we need medical ontology. The term “medical ontology” we understand to mean the (...) study that seeks to ascertain what entities exist in the world of medicine, which formal relations hold between them, and whether there are any relatioships between types of medical research and practice, on the one hand; and the new worlds they create, on the other. (shrink)

RESUMEN Francis Bacon y René Descartes han sido presentados tradicionalmente como pioneros de corrientes filosóficas opuestas entre sí. Sin embargo, son cada vez más los estudios que muestran importantes continuidades entre sus filosofías. Este artículo explora una de ellas: sus perspectivas sobre la medicina. El dominio sobre la naturaleza y el instinto de autoconservación son los elementos centrales del marco teórico dentro del cual se inserta su valoración de la medicina como la disciplina más destacada por sus beneficios para el (...) cuidado del ser humano. A partir de ahí son muchas sus coincidencias acerca del estatus, la práctica y la reforma de la medicina. ABSTRACT Francis Bacon and René Descartes have traditionally been presented as leaders of opposed philosophical currents. However, more and more studies show important continuities between their philosophies. This article explores one of them: their perspectives on medicine. The dominion over nature and the instinct for self-preservation are the central elements of the theoretical framework within which they inserted their assessments of medicine. Medicine is valued as the most outstanding discipline for its benefits for the care of the human being. Departing from this start-point, one finds further coincidences about the status, practice, and reform of medicine. (shrink)

This contribution examines the important role that medical experts and expertise played at convivial networking events in the High Roman Empire, as imagined by a non-specialist in the field, viz. the famous Platonist intellectual Plutarch of Chaeronea. An analysis of a number of medical problems discussed in his Table Talk will yield fresh insights into the social and intellectual role which doctors, as members of the educated elite, were expected to play in convivial community contexts and also how popular or (...) common had become certain theories, concepts and beliefs relating to health and healing in the High Imperial era. At the same time, it will give a clearer idea of what was the place of medical experts and expertise in Plutarch’s intellectual programme, and how this interest ties in with his philosophical endeavours more generally. (shrink)

In this paper we focus on some new normativist positions and compare them with traditional ones. In so doing, we claim that if normative judgments are involved in determining whether a condition is a disease only in the sense identified by new normativisms, then disease is normative only in a weak sense, which must be distinguished from the strong sense advocated by traditional normativisms. Specifically, we argue that weak and strong normativity are different to the point that one ‘normativist’ label (...) ceases to be appropriate for the whole range of positions. If values and norms are not explicit components of the concept of disease, but only intervene in other explanatory roles, then the concept of disease is no more value-laden than many other scientific concepts, or even any other scientific concept. We call the newly identified position “value-conscious naturalism” about disease, and point to some of its theoretical and practical advantages. (shrink)

Displacing the physiological model that had held sway in 19th-century medical thinking, early 20th-century hormone research promoted an understanding of the body and sexual desires in which variations in sex characteristics and non-reproductive sexual behaviours such as homosexuality were attributed to anomalies in the internal secretions produced by the testes or the ovaries. Biotypology, a new brand of medical science conceived and led by the Italian endocrinologist Nicola Pende, employed hormone research to study human types and hormone treatments to normalise (...) individuals who did not conform to accepted medical norms. Latin American medical doctors, eugenicists, and sexologists took up biotypology with enthusiasm. This article considers the case studies of Italy, Argentina, and Brazil, and analyses the work of medical doctors who adopted a biotypological mode of reasoning and employed to various extents hormone therapies in their practice. By focusing on hormone therapies that aimed to normalise secondary sexual characteristics and the sexual instinct, the article suggests that while the existence of normality was contested to the point that a number of medical scientists argued that no such thing existed, the pursuit of normality was carried out in very practical terms through the new medical technologies hormone research had introduced. (shrink)

I respond to the 4 commentaries by Awais Aftab & Kristopher Nielsen, Hane Htut Maung, Diane O’Leary and Kathryn Tabb under 3 main headings: “What is the BPSM really?” & Why update it?; “Is our approach foundationally compromised?”, and finally, “Antagonists or fellow travellers?”.

Calls for evidence-based approaches to COVID-19 have sparked up discussions on the use of evidence for policy. In this note, we expand these discussions: while the debate has mostly focused on the types of evidence to be used for policy, we argue that the assessment of judgments involved in data practices and evidence production should play a central role in evaluating policy.

In the conclusion to the first book of the Treatise, Hume's skeptical reflections have plunged him into melancholy. He then proceeds through a complex series of stages, resulting in renewed interest in philosophy. Interpreters have struggled to explain the connection between the stages. I argue that Hume's repeated invocation of the four humors of ancient and medieval medicine explains the succession, and sheds a new light on the significance of skepticism. The humoral context not only reveals that Hume conceives of (...) skepticism primarily as a temperament, not a philosophical view or system. It also resolves a puzzle about how Hume can view skepticism as both an illness and a cure. The skeptical temperament can, depending on its degree of predominance, either contribute to or upset the balance of temperaments required for proper mental functioning. (shrink)

Historians have often represented prayer as an instrumental response to illness. We argue instead that prayer, together with physic, was part of larger regimes to preserve health and prevent disease. We focus on early modern England, through the philosophical writings of the physician, Robert Fludd, and the medical records of the clergyman, Richard Napier. Fludd depicted health as a fortress and illness as an invasion by demons; the physician counsels the patient in maintaining and restoring moral and bodily order. Napier (...) documented actual uses of prayer. As in Fludd’s trope, through prayer, Napier and his patients enacted their aspiration for health and their commitment to a Christian order in which medicine only worked if God so willed it. Prayer, like physic, was a key part of a regime that the wise practitioner aimed to provide for his patients, and that they expected to receive from him. (shrink)

This is the first book to explore the epistemology and ethics of advanced imaging tests, in order to improve the critical understanding of the nature of knowledge they provide and the practical consequences of their utilization in healthcare. Advanced medical imaging tests, such as PET and MRI, have gained center stage in medical research and in patients’ care. They also increasingly raise questions that pertain to philosophy: What is required to be an expert in reading images? How are standards for (...) interpretation to be fixed? Is there a problem of overutilization of such tests? How should uncertainty be communicated to patients? How to cope with incidental findings? This book is of interest and importance to scholars of philosophy of medicine at all levels, from undergraduates to researchers, to medical researchers and practitioners (radiologists and nuclear physicians) interested in a critical appraisal of the methodology of their discipline and in the ethical principles and consequences of their work. -/- . (shrink)

In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for (...) a tighter integration of the social sciences in future evidence-based policy-making. This demand faces challenges on different levels, which we identify and discuss as potential inhibitors for a more pluralistic evidential basis. (shrink)

The paper investigates the epistemological and communicative competences the experts need to use and communicate evidence in the reasoning process leading to diagnosis. The diagnosis and diagnosis communication are presented as intertwined processes that should be jointly addressed in medical consultations, to empower patients’ compliance in illness management. The paper presents defeasible reasoning as specific to the diagnostic praxis, showing how this type of reasoning threatens effective diagnosis communication and entails that we should understand diagnostic evidence as defeasible as well. (...) It argues that metaphors might be effective communicative devices to let the patients understand the relevant defeasors in the diagnostic reasoning process, helping to improve effective diagnosis communication, and also encouraging a change in patients’ beliefs and attitudes on their own experience of illness and illness’ management. (shrink)

In 1913, eccentric French composer Erik Satie wrote a fragmentary, diary-like essay where he depicted a strikingly rigid diet consisting solely of white foods: eggs, sugar, coconuts, rice, cream cheese, fuchsia juice and so on. Satie’s brief essay has later been used as one of many puzzle pieces in attempts to retrospectively diagnose him with autism spectrum disorder. With Satie’s white meal as a starting point, this paper explores colour-based food preferences and selective eating in clinical and non-clinical populations, with (...) a special focus on autism spectrum disorder and avoidant/restrictive food intake disorder. General colour preferences and their causes as well as the impact of colour on taste and food identification are also explored. Selective eating during childhood is immensely common and does not generally lead to disordered eating in the long run, although subgroups may experience rigidity around food of a more enduring nature. Problems related to eating were repeatedly described in Kanner’s original 1943 autism case series and continue to be common in autism. Most studies on eating and sensory sensitivity in autism show that the texture and consistency of the food are the most common factors behind selective eating. In contrast, colour-based food preferences appear to be relatively rare, although numerous anecdotal reports exist. Foods that are white or colourless may be particularly appealing or tolerable for individuals with sensory hypersensitivity, which can occur in autism or ARFID. Ultimately, in the case of Erik Satie, this paper concludes that his description of a strictly white diet should not be read as an autobiographical account but rather as an ironic take on contemporary symbolist literature, with the famously decadent all-black dinner party in French novelist Joris-Karl Huysmans’ À Rebours as an obvious source of inspiration. (shrink)

The term ‘heat’ originates from the Old English word hǣtu, a word of Germanic origin; related to the Dutch ‘hitte’ and German ‘Hitze’. Today, we distinguish three different meanings of the word ‘heat’. First, ‘heat’ is understood in colloquial English as ‘hotness’. There are, in addition, two scientific meanings of ‘heat’. ‘Heat’ can have the meaning of the portion of energy that changes with a change of temperature. And finally, ‘heat’ can have the meaning of the transfer of thermal energy (...) from a hotter to a colder system or body. By contrast, for the Ancients and Scholastics, ‘heat’ was a manifest, real quality of bodies and there was an ontological distinction between biological or innate heat (which was regarded as an innate principle of life for warm-blooded animals) and the physical manifest heat of external objects, which is potentially harmful. During the late Renaissance period, however, both views changed fundamentally and evolved - via the application of physical and mechanical analogies - into the foundations for today’s unified mechanistic theory of heat. (shrink)

In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’, and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, be (...) treated as closely related concerns and not simply as externally related agendas. To support our argument, we explore the gap between ‘quality’ and ‘ethics’ discourses and ask about the possible differences between ‘good quality healthcare’ and ‘good healthcare’. We suggest that the word ‘quality’ both adds to and subtracts from the idea of ‘good healthcare’, and in particular that the technicist inflection of quality discourses needs to be set in the context of broader conceptualisations of healthcare improvement. We introduce the distinction between quality as a measurable property and quality as an evaluative judgement, suggesting that a core, but neglected, question for an ethics of healthcare improvement is striking the balance between these two conceptions of quality. (shrink)

One of the Belmont Report’s most important contributions was the clear and serviceable distinction it drew between standard medical practice and biomedical research. A less well-known achievement of the Report was its conceptualization of innovative practice, a type of medical practice that is often mistaken for research because it is new, untested, or experimental. Although the discussion of innovative practice in Belmont is brief and somewhat cryptic, this does not reflect the significant progress its authors made in understanding innovative practice (...) and the distinctive ethical issues it raises. This article explores the history and broader context of Belmont’s conception of innovative practice, its strengths and weaknesses, and its contemporary relevance for scholars working in bioethics and health policy. While this conception of innovative practice deserves our attention, it is inherently limited in some important ways. (shrink)

The mantra that "the best way to predict the future is to invent it" (attributed to the computer scientist Alan Kay) exemplifies some of the expectations from the technical and innovative sides of biomedical research at present. However, for technical advancements to make real impacts both on patient health and genuine scientific understanding, quite a number of lingering challenges facing the entire spectrum from protein biology all the way to randomized controlled trials should start to be overcome. The proposal in (...) this chapter is that philosophy is essential in this process. By reviewing select examples from the history of science and philosophy, disciplines which were indistinguishable until the mid-nineteenth century, I argue that progress toward the many impasses in biomedicine can be achieved by emphasizing theoretical work (in the true sense of the word 'theory') as a vital foundation for experimental biology. Furthermore, a philosophical biology program that could provide a framework for theoretical investigations is outlined. (shrink)

While De Pestilitate is generally regarded as pseudepigraphic by modern scholarship, the treatise occupied a prominent place in Johann Huser’s definitive edition of Paracelsus’ Bücher und Schrifften. The text offers a compelling and generally reliable guide to Paracelsian plague theory with clear resemblances to the authentic Zwey Bücher von der Pestilentz und ihren zufällen and De Peste Libri tres. The text emphasizes the astrological transmission of the disease, describes a large role for divine retribution and demonological agency, and promotes the (...) utility of folkloric cures. While the plague theory reflects Paracelsus’ own thought and is well synthesized with his tria prima chemical philosophy, there are sufficient dissonances between the text and the corpus of his accepted writings to maintain its pseudepigraphic status, even if it displays some indications of a reworking of genuine Paracelsica. (shrink)

This paper brings both textual and ethnographic considerations to bear on Ibn Abī Ṣādiq’s medico-philosophical commentary on the Hippocratic Apho­risms. He considers cases of madness and absence of pain in order to discuss the problem of ikhtilāṭ al-ʿaql and its relation to the body, soul, and spirit. Focusing on ikhtilāṭ offers a space to examine an important configuration at the limit of the physical, the metaphysical, and spiritual. Ultimately, a close reading of Ibn Abī Ṣādiq’s commentaries moves toward a theoretical (...) psychology and a medico-philosophical language of the subjective experience of pain. (shrink)

This paper studies the “human circulatory statues” which Salomon Reisel designed in the 1670s in order to demonstrate the circulation of the blood and its effect on the brain. It investigates how Reisel intended this project to promote Descartes’ philosophy, and how it relates to contemporary diagrammatic schematizations of the blood circulation system. It further explores Reisel’s claims concerning the epistemological and practical advantages of working with a three-dimensional model and argues that Reisel intended his statua to address the concerns (...) of his fellow physicians and, more specifically, to help in diagnostics. I consider the background, strategy and legacy of the essays in which Reisel presented his devices, as well as their relevance to the general project of the scien­tific journal – one of the earliest – in which they appeared, the Miscellanea Curiosa. Reisel was a leading physician who acted throughout his life as a mediator between the Royal Society and the Academia Naturæ Curiosorum. His articles, the paper argues, have much to tell us much about the role played by the recently established scientific academies and their journals in shaping the transmission of early modern science and medicine, in terms both of theories and of the knowledge embodied in scientific instruments. (shrink)

'Quality' is a widely invoked concept in healthcare, and 'quality improvement' is now a central part of healthcare service delivery. However, these concepts and their associated practices represent relatively uncharted territory for applied philosophy and bioethics. In this paper, we explore some of the conceptual complexity of quality in healthcare and argue that quality is best understood to be conceptually plural. Quality is widely agreed to be multidimensional and as such constitutively plural. However, we argue that quality is plural in (...) two further senses. First, quality is competitively plural : that is, different high-level conceptions of quality can be appropriately invoked in different contexts and serve... (shrink)

Wolfgang Reichart was a humanist and a town physician of Ulm. His work consists of a largely unpublished collection of nearly 600 texts. So far, it has been claimed that this compilation only consists of letters and poems. However, we have found a medical treatise, wherein Reichart discusses a case of impotence, its pathophysiology and therapy. One of the crucial aspects in this text is the relationship it describes between witchcraft and medicine. The patient claims that his condition is the (...) result of bewitchment. Reichart accepts witchcraft as a possible aetiological explanation, but claims that since the processes triggered by witchcraft are still natural, the patient can be cured by natural means. Thus, Reichart’s approach is an important contribution to the history of medicine and to the history of science of the early modern period. We provide the first edition, translation, and commentary of the text. (shrink)

Within the evidence-based medicine construct, clinical expertise is acknowledged to be both derived from primary experience and necessary for optimal medical practice. Primary experience in medical practice, however, remains undervalued. Clinicians’ primary experience tends to be dismissed by EBM as unsystematic or anecdotal, a source of bias rather than knowledge, never serving as the “best” evidence to support a clinical decision. The position that clinical expertise is necessary but that primary experience is untrustworthy in clinical decision-making is epistemically incoherent. Here (...) we argue for the value and utility of knowledge gained from primary experience for the practice of medicine. Primary experience provides knowledge necessary to diagnose, treat, and assess response in individual patients. Hierarchies of evidence, when advanced as guides for clinical decisions, mistake the relationship between propositional and experiential knowledge. We argue that primary experience represents a kind of medical knowledge distinct from the propositional knowledge produced by clinical research, both of which are crucial to determining the best diagnosis and course of action for particular patients. (shrink)

Positive claims about narrative approaches to healthcare suggest they could have many benefits, including supporting person-centred healthcare (PCH). Narrative approaches have also been criticised, however, on both theoretical and practical grounds. In this paper we draw on epistemological work on narrative and knowledge to develop a conception of narrative that responds to these concerns. We make a case for understanding narratives as accounts of events in which the way each event is described as influenced by the ways other events in (...) the narrative are described. This view of narratives recognises that they can contribute knowledge of different kinds of connections between events: not just causal, and not just of patient’s perspectives. Additionally, narratives can add further epistemic value by suggesting potentially useful lines of inquiry. We take narrative approaches to healthcare to include clinicians considering both patients’ informational offerings and their own professional understandings as narratives. On this understanding, our account is able to overcome the major theoretical and practical criticisms that have been levelled against the use of narrative approaches in healthcare, and can help to explain why and how narrative approaches are consistent with PCH. (shrink)

How have and how might philosophers contribute to linking disability and activism in these peri-COVID-19 times, especially in forms of public engagement that go beyond podcasted talks and articles aimed at a public audience? How do we harness philosophical thinking to contribute positively to those living with disability whose vulnerabilities are heightened by this pandemic and the ableism highlighted by collective responses to it?